Women with current or past hormone-sensitive cancer, unexplained vaginal bleeding, active liver disease, a history of venous thrombosis, previous stroke or heart attack, or known thrombophilia. Several of those need specialist input rather than an automatic refusal.
Absolute
Los Angeles safety review: situations that rule it out
Anything left out of your history changes what a Los Angeles clinician can sign off on, so bring records from any specialist you have seen. Current or past hormone-sensitive breast cancer, and other estrogen-dependent cancers, are generally contraindications to systemic therapy. Local vaginal estrogen is a separate question to raise with your oncology team.
Unexplained vaginal bleeding must be investigated before any hormone is prescribed. Starting treatment first can mask the cause of something that needs diagnosing, and that delay can matter a great deal.
Active liver disease, a history of venous thrombosis or pulmonary embolism, previous stroke or heart attack, and known thrombophilia all rule out or substantially complicate systemic therapy. There is more in breast cancer and hrt, safety and risks and vaginal estrogen for the rest of it. Each of these is asked about directly at a Los Angeles assessment, because a history you have not thought about for years still changes the answer.
